Schooley Benjamin, Walczak Steven, Hikmet Neset, Patel Nitin
Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA.
Integrated Information Technology Department, University of South Carolina, 1301 Gervais St., Columbia, SCS, USA; School of Information & Florida Center for Cybersecurity, University of South Florida, Tampa, FL, USA.
Int J Med Inform. 2016 Apr;88:62-70. doi: 10.1016/j.ijmedinf.2016.01.010. Epub 2016 Jan 25.
Health information technology investments continue to increase while the value derived from their implementation and use is mixed. Mobile device adoption into practice is a recent trend that has increased dramatically and formal studies are needed to investigate consequent benefits and challenges. The objective of this study is to evaluate practitioner perceptions of improvements in productivity, provider-patient communications, care provision, technology usability and other outcomes following the adoption and use of a tablet computer connected to electronic health information resources.
A pilot program was initiated in June 2013 to evaluate the effect of mobile tablet computers at one health provider organization in the southeast United States. Providers were asked to volunteer for the evaluation and were each given a mobile tablet computer. A total of 42 inpatient and outpatient providers were interviewed in 2015 using a survey style questionnaire that utilized yes/no, Likert-style, and open ended questions. Each had previously used an electronic health record (EHR) system a minimum of one year outside of residency, and were regular users of personal mobile devices. Each used a mobile tablet computer in the context of their practice connected to the health system EHR.
The survey results indicate that more than half of providers perceive the use of the tablet device as having a positive effect on patient communications, patient education, patient's perception of the provider, time spent interacting with patients, provider productivity, process of care, satisfaction with EHR when used together with the device, and care provision. Providers also reported feeling comfortable using the device (82.9%), would recommend the device to colleagues (69.2%), did not experience increased information security and privacy concerns (95%), and noted significant reductions in EHR login times (64.1%). Less than 25% of participants reported negative impacts on any of these areas as well as on time spent on order submission, note completion time, overall workload, patient satisfaction with care experience and patient outcomes. Gender, number of years in practice, practice type (general practitioner vs. specialist), and service type (inpatient/outpatient) were found to have a significant effect on perceptions of patient satisfaction, care process, and provider productivity.
Providers found positive gains from utilizing mobile devices in overall productivity, improved communications with their patients, the process of care, and technology efficiencies when used in combination with EHR and other health information resources. Demographic and health care work environment play a role in how mobile technologies are integrated into practice by providers.
卫生信息技术投资持续增加，但其实施和使用所产生的价值却参差不齐。将移动设备应用于医疗实践是最近一种急剧增长的趋势，需要进行正规研究以调查随之而来的益处和挑战。本研究的目的是评估从业者在采用和使用连接电子健康信息资源的平板电脑后，对生产力提升、医患沟通、医疗服务提供、技术易用性及其他结果的看法。
2013年6月启动了一项试点项目，以评估美国东南部一家医疗服务机构中移动平板电脑的效果。邀请医疗服务提供者自愿参与评估，并为每人提供一台移动平板电脑。2015年，使用一份调查问卷对42名住院和门诊医疗服务提供者进行了访谈，问卷采用是/否、李克特量表式和开放式问题。每位参与者此前在住院医师培训之外至少已使用电子健康记录（EHR）系统一年，并且是个人移动设备的常规用户。他们在医疗实践中使用与卫生系统EHR相连的移动平板电脑。
调查结果表明，超过一半的医疗服务提供者认为使用平板电脑对医患沟通、患者教育、患者对医疗服务提供者的看法、与患者互动的时间、医疗服务提供者的生产力、护理过程、与该设备一起使用时对EHR的满意度以及医疗服务提供有积极影响。医疗服务提供者还报告说使用该设备感觉舒适（82.9%），会向同事推荐该设备（69.2%），没有体验到信息安全和隐私担忧增加（95%），并指出EHR登录时间显著减少（64.1%）。不到25%的参与者报告在这些方面以及订单提交时间、记录完成时间、总体工作量、患者对护理体验的满意度和患者结局方面有负面影响。研究发现，性别、从业年限、执业类型（全科医生与专科医生）和服务类型（住院/门诊）对患者满意度、护理过程和医疗服务提供者生产力的看法有显著影响。
医疗服务提供者发现，在与EHR和其他健康信息资源结合使用时，利用移动设备在整体生产力、改善与患者的沟通、护理过程和技术效率方面有积极收获。人口统计学特征和医疗工作环境在医疗服务提供者将移动技术整合到实践中的方式上发挥着作用。
